I find following a good leader very exciting and highly empowering. In fact, given a choice, I much more enjoy following a good, inspirational leader than lead myself. But I also find good leadership scarce. And until fairly recently my implicit assumptions were that (i) for most of the time we can’t expect good leadership and so (ii) we have to just carry on despite the leaders we’ve been dealt with.
The recent events in the UK politics have challenged me to think about this differently. For those who have missed the events: a year ago the UK Labour party elections resulted in a new, different type of a leader for the party (a man called Jeremy Corbyn). Many powerful people in the party have not accepted him as the leader, and have gone in a long standing rebellion. At the same time, the other major party Conservatives also erroded their leader through a big dispute over the EU. In both cases, the styles, views and policies of the two leaders were not liked and agreed to by some of the big names (‘front benchers’) within the parties.
Now this is nothing new, there has always been ousting and power battle. But what has been interesting to me in listening to all this is that the big name front benchers have basically gone into mutiny and refused to serve the boss. Usually the rebellion would only happen from the ‘back benches’, i.e. among the people who have a lot less power. And this has made it seem different to the usual squabbles. And has made me pay attention and compare it to the life of a clinician academic.
There are of course major differences between being an elected politician versus being an employed clinician academic. But if we suspend those differences for a while, and follow some interesting avenues of hypothetical reflection (a kind of a thought experiment). Namely, what if we didn’t agree to just quietly accept poor clinical/academic/clinical academic leaders? What if we too went into mutiny? How would that look like, and what would happen? Also, on reverse, what does it say about us that we pretty much never (at least openly) rebel?
One question that has been debated in relation to the political parties is “Is my loyalty to the organisation (i.e. the party and the values and ideals it promotes), to its leadership (i.e. the people currently in charge), or to the people we are meant to serve (i.e. the voters)?” Translated to the situation of a clinician academic, this could mean choosing between loyalty to (i) the NHS and/or University and the ideas and values that these represent (e.g. health, education), vs to (ii) the people currently in charge of these organisatios (anyone from a team lead to the top chief), vs to (iii) the patients and the wider public. If we were to go in mutiny, where would our loyalties lie?
I’m personally not quite sure what to think about this. I believe that the ideas and values that these organisations represent are bigger than any one of us, and it’s the ideas and values I’m committed to. But I also feel strong commitment to the patients and the public. In turn, my commitment to the people in charge is conditional for their actions aligning with the bigger values and the benefits to the patients and the public. This does not sound so different to what the politicians are saying…. They seem to be all about the commitment to the “Labour/Conservative values” and “accountability to the voter”… So let’s stretch the analogy and thought experiment further.
Let’s say I am committed to the core NHS and university values, and to the patients and the public, but I believe my leader(s) are not facilitative of these? Or worse, if I believe that one or more of the leaders are actively obstructive?
At a simple level, I suppose we clinician academics can move from one NHS organisation or university to another. Basically go and work under a leader who better facilitates the mission. In fact, many people do this. And we probably should collectively do more of this. Because, aren’t we only propping up bad leaders by doing good work under them? Aren’t we just keeping a stinky ship on the sea when actually we should let it sink – so that a genuinely good ship could be brought in to replace it?
This is not a trivial question. For example, in the UK, the latest NHS staff survey showed that over a quarter (27%) of heathcare staff believe they are serving under a leadership that does not consider patient outcomes a priority. Nearly half of the staff (44%) think that their leaders would not address concerns about patient care if these were raised. If all these people still do good work and deliver good outcomes despite their leaders then they are actually propping up leaders that, at face value, do not seem to support either the broad value of health or the focus on patient benefit. These staff are keeping up the patient satisfaction stats and the health outcome figures that allow the leader to stay. They are preventing a move to better. This is a key argument used by the rebelling politicians in the UK – they argue that they have a responsibility to voice concerns and to rebel as otherwise they would be supporting something they believe is harmful for the bigger values and the people. So perhaps enough parallel there to continue with the thought experiment a bit more….?
If we conclude that silently carrying on under a bad (or at least ineffective) leader is a no-no, then what? Personally, for me, this is where the difficult bit really lies. I am, in principle, ok to refuse to serve a bad leader, to raise my objections with them, and to leave for another organisation if I think there really is no hope for change. However, I find it really difficult to judge whether the leader is actually ‘bad’. E.g. maybe they are obstructive/ineffective in only some aspects? Or perhaps they have good reasons to do what to me seems like obstructive; maybe I am just mistaken (e.g. they will know more about the financial landscape and other organisational pressure than I do, and so can be assumed to make more informed decisions)? Or maybe it’s just a case of differing approaches to doing things, and maybe mine is actually the wrong one while their’s is right? There are a million questions to work through.
Another part of this is, at least for me, that may be there are other reasons for staying and trying to make it work. E.g. maybe we have built something very good with the colleagues. Something that is actually serving patients very well – and leaving that open to be torn down by the bad leader just seems wrong. Patients still deserve good care and outcomes, even if they are unfortunate to live in an area where there are bad leaders, right? But this starts to sound like a sort of Robin Hoods of health care – buffering between bad leaders and the deserving patients… Is this really the way to progress?
I think I am increasingly convinced that bad leaders are not just an inconvenience but that they result in worse care and outcomes. Care that is substantially worse than it would have been had there been a good leader in place. Even if we don’t notice it immediately, over time ineffective leaders stagnate development and innovation, and demoralise and de-skill staff. While teams with good leaders improve, the teams with bad leaders stay the same or improve less.
So what’s the conclusion to clinician academics? I am not sure. The original case example of UK political parties offers no straight solution either – their power struggles, rebellions and differences of opinions continue. But perhaps there is something I have learnt from this, and that is a greater mindfulness about my leaders. I don’t have to stick with bad leaders, and it’s probably healthy to seek to discuss concerns about leadership more openly than we currently do. And perhaps this is a key leadership role that we as clinician academics should expect to take (and are well placed to take)?
What do you all think? What are your takes and experiences on serving, as a clinician academic, under an inspirational or a dissapointing leader?
[Disclaimer: The above is intended as a thought experiment to promote discussion about how we engage with issues related to good and poor leadership, and should not be read as anything more than that.]